University Hospital Basel, Psychiatric Outpatient Department, Petersgraben 4, CH-4031 Basel, Switzerland.
J Psychiatr Res. 2010 May;44(7):447-53. doi: 10.1016/j.jpsychires.2009.10.008. Epub 2009 Nov 25.
Hippocampal volume (HV) reduction is well documented in schizophrenia. However, it is still unclear whether this change is a pre-existing vulnerability factor, a sign of disease progression, a consequence of environmental factors, such as drug use, antipsychotic medication, or malnutrition. The timing of HV changes is not well established, but a lack of macrostructural hippocampal brain abnormalities before disease onset would rather support a neuroprogressive illness model.
To investigate the timing of HV changes in emerging psychosis.
A cross-sectional MRI study of manually traced HVs in 37 individuals with an At Risk Mental State (ARMS) for psychosis, 23 individuals with First-Episode Psychosis (FEP), and 22 Healthy Controls (HC) was performed. We compared left and right HVs corrected for whole brain volume across groups using analysis of covariance (ANCOVA) with gender as a covariate. Sixteen of 37 ARMS individuals developed a psychotic disorder during follow up (ARMS-T). The mean duration of follow up in ARMS was 25.1months.
The overall ANCOVA model comparing left HVs across FEP, ARMS and HC indicated a significant general group effect (p<.05) with largest volumes in ARMS and smallest in FEP. ARMS-T subjects had significantly larger left HVs compared to FE but no HV differences compared to HC (p<0.05). Over all groups, we found an asymmetry between the left and right mean HVs and a strong effect of sex.
The present study suggests that macrostructural hippocampal abnormalities probably occur in the context of the first psychotic breakdown.
精神分裂症患者的海马体积（HV）减少已得到充分证实。然而，目前尚不清楚这种变化是预先存在的脆弱性因素、疾病进展的标志、还是环境因素（如药物使用、抗精神病药物或营养不良）的结果。HV 变化的时间尚不清楚，但在疾病发作前缺乏宏观结构的海马脑异常，更支持神经进行性疾病的模型。
研究精神分裂症早期 HV 变化的时间。
对 37 名有精神病风险的精神状态（ARMS）、23 名首发精神病（FEP）和 22 名健康对照（HC）的 MRI 进行手动追踪 HVs 的横断面研究。我们使用协方差分析（ANCOVA）比较了左、右 HVs 与全脑体积的比值，以性别为协变量。37 名 ARMS 中有 16 名在随访期间出现了精神病（ARMS-T）。ARMS 的平均随访时间为 25.1 个月。
FEP、ARMS 和 HC 之间比较左 HVs 的整体 ANCOVA 模型表明存在显著的总体组效应（p<0.05），ARMS 组的体积最大，FEP 组的体积最小。与 FE 相比，ARMS-T 患者的左 HV 明显更大，但与 HC 相比，HV 无差异（p<0.05）。在所有组中，我们发现左、右 HV 之间存在不对称性，且性别影响强烈。
本研究表明，宏观结构的海马异常可能发生在第一次精神病发作的背景下。
